More than 75,000 workers employed with the Kaiser Permanente hospital systems are poised to strike this week, citing wage and staffing issues in what looks to be the largest health care strike in U.S. history.

The Coalition of Kaiser Permanente Unions represents over 85,000 health care workers in Kaiser Permanente facilities in seven states and the District of Columbia. Kaiser last negotiated a contract with the coalition in 2019, a year before the COVID-19 pandemic broke out. On Sept. 30 this year, the contract expired. On Sept. 22, the coalition submitted a 10-day notice to Kaiser Permanente executives, warning that they would begin striking on Oct. 4 if a better contract is not negotiated. With the deadline fast approaching and no deal in sight, the strike looks set to start at 6 a.m. on Wednesday.

Over 75,000 workers in California, Oregon, Washington, Colorado, Virginia, and Washington D.C. will take part, “making it the largest healthcare worker strike in U.S. history,” the coalition said in a Sept. 22 statement. The strike would last for four days until 6 a.m., Oct. 7, and affect hundreds of facilities.

According to the coalition, Kaiser executives have proposed raising wages between 2 and 4 percent, which it says is an “offensive raise proposal that fails to keep up with the cost of living for anyone.”

It accused the management of committing “unfair labor practices,” seeking to slash the employees’ performance-sharing bonus to 50 percent of its current value, failing to address the “growing staff shortage,” and seeking to eliminate protections against subcontracting and outsourcing.

The coalition also slammed the executives for wanting remote workers to permanently report to work at a Kaiser facility “with just two weeks’ notice.”

“If Kaiser continues to commit unfair labor practices, we are prepared to engage in another longer, stronger strike in November to protest Kaiser’s unfair labor practices,” it warned. This strike would see additional coalition members from Washington—whose contract expires Oct. 31—join the protest.

“Kaiser executives continue to bargain in bad faith over the solutions we urgently need to the Kaiser short-staffing crisis and the safety and well-being of our patients and workers is on the line,” the union said.

In a statement to Axios, a Kaiser spokesperson said on Monday that the two parties “agreed this morning to continue to meet through midday Tuesday if needed, to reach an agreement. A strike is not inevitable, and it is certainly not justified.”

However, the coalition told the outlet on Monday afternoon that they “will go on strike.”

Kaiser Permanente is the largest nonprofit, private health care organization in the United States. It serves almost 13 million patients and runs 39 hospitals and over 600 medical offices in eight states and D.C. The hospital system employs over 305,000 people.

Hospital Disruption, Staffing Shortage

Even though only 75,000 out of Kaiser’s over 305,000 employees will be participating in the strike beginning Oct. 4, the protest involves employees who are crucial to providing patient care at the hospital system—nurses, EMTs, respiratory therapists, ultrasound sonographers, radiology and X-ray technicians, and hundreds of other positions.

In Georgia, Hawaii, and Washington, no patients are expected to be affected by the strike, said a Kaiser spokesperson, according to CNN. In these three states, operations would continue as normal. In Virginia and the District of Columbia, pharmacists and optometrists would be striking.

In the states of Colorado, California, and Oregon, the strike’s effects on patients could turn out to be “more substantial,” the spokesperson said.

“We have detailed continuity plans in place in all of these markets that include the use of non-represented and management staff along with contingency workers. In addition, all our physicians will be available.”

However, John August, the former executive director of the Coalition of Kaiser Permanente Unions, told the outlet that working with fewer employees would be a tough task at the hospital system.

“Managers are still going to be there. The doctors are still going to be there. From the outside looking in, it’s easy to say that it’s not going to be that disruptive … The reality is, it’s extremely disruptive,” he said.

During a smaller strike last year that involved mental health care workers at Kaiser, some patients saw their appointments get canceled.

Staff shortage is a key issue being raised by the labor coalition. “It just seems like there is no concern for short-staffing and patient care,” said Henry Perez, an intensive care unit secretary at Kaiser Permanente in Modesto, California, according to The Guardian.

Mr. Perez said that there are days when he has to do the work of two, three, or four other unit assistants. A shortage of workers also harms patients as they have to wait longer for assistance, he said.

“On top of having my unit, I will have the entire hospital, which is 102 patients I’m responsible for and it causes burnout, it causes mental anguish, it causes stress. I see my nurses I support and we’re constantly running on fumes because of staffing.”

Kaiser said it’s aggressively recruiting to fill more positions, according to Axios. It has reached a deal with the labor coalition to hire 10,000 new workers by the end of this month, a goal it expects to hit, the company stated.